Provider Demographics
NPI:1871780718
Name:GONZALEZ, ALAN G (DMD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:G
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 BRICKELL BAY DR APT 914
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3666
Mailing Address - Country:US
Mailing Address - Phone:786-306-3188
Mailing Address - Fax:
Practice Address - Street 1:1408 BRICKELL BAY DR APT 914
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-3666
Practice Address - Country:US
Practice Address - Phone:786-306-3188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN171621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice